PsyDactic
A resource for psychiatrists and other medical or behavioral health professionals interested in exploring the neuroscientific basis of psychiatric disorders, psychopharmacology, neuromodulation, and other psychiatric interventions, as well as discussions of pseudoscience, Bayesian reasoning, ethics, the history of psychiatry, and human psychology in general. This podcast is not medical advice. It strives to be science communication. Dr. O'Leary is a skeptical thinker who often questions what we think we know. He hopes to open more conversations about what we don't know we don't know. Find transcripts with show-notes and references on each episodes dedicated page at psydactic.buzzsprout.com. You can leave feedback at https://www.psydactic.com. The visual companions, when available, can be found at https://youtube.com/@PsyDactic.
Episodes
-- Dr. O’Leary interviews forensic psychiatrist and author Dr. Michael Schirripa about his career as a forensic psychiatrist, the release of his first thriller, Mindhunt, and his podcast Mindhunting. Dr. Shirripa explores how his love of literature influenced his decision to pursue forensic psychiatry and ultimately resulted in his creation of an international thriller with an ambitious forensic psychiatr...
- - In the world of psychotropic medication, the question is not just whether it works or not, but whether it works better than a placebo and whether the effect size is clinically significant and the benefits outweigh the risks. In the case of MDMA (aka molly or ecstasy), the effect size for improving post-traumatic stress disorder symptoms reported by researchers has been very large. Often it is found to b...
The Narrative Fallacy describes our tendency to find meaning, connections, and causal relationships where they do not necessarily exist. In this episode, Dr. O'Leary had the pleasure of interviewing Dr. Alexey Tolchinsky.
He recently published a paper called “Narrative fallacy and other limitations of psychodynamic case formulation.” Dr. Tolchenski did not invent the idea of the Narrative...
Dr. O'Leary discusses a variety of concerns that all clinicians should have in mind when using psychometrics. In the end, he hopes you come away with some level of agreement with the statement: “Our primary concern should not be with the quantity of data, but with the quality of the data.” Statistics are conceptual machines that will produce results no matter what you feed them. These results can be ...
In this episode, Dr. O'Leary discusses a word that he has struggled to understand since medical school. The word is aphasia. The root “phasia” comes from the Greek phanai which means “to speak.” When aphasia is used medically, it refers to an inability to speak, although not always. More generally it is often used to mean a failure to understand or produce language, but it gets complicated. Dr. O&ap...
I did not until recently even consider the cerebellum when thinking about psychiatric conditions, but the more I read, the more I wonder why the cerebellum is not considered a potential important player in nearly every psychiatric disorder. Although it can be said that all brain regions primarily function to make predictions, the cerebellum is especially active at refining impromptu predictions through short...
The thalami are bilaterally symmetrical structures in the subcortical part of the brain that are cradled by the basal ganglia. They are major hubs of pretty much everything your brain does and all of the sensory information coming into the brain with the exception of smell.
More primitive models of the brain visualized it as a bunch of relatively isolated modules, each specialized to perform a singl...
In this episode, I discuss a medication that patients who saw a psychiatrist or their primary care provider between about 1997 and 2015 were very likely to find themselves prescribed. More recently, it has been taken down a notch or two on prescribers lists of preferred meds. This medication is quetiapine, marketed as Seroquel by AstraZeneca in the US. Whether you were diagnosed with schizophrenia, bipolar...
This episode continues an intermittent series called “In a Word.” Past episodes have explored words like Akathisia, Dissociation, Perseveration, and even the difference between Impulsive and Compulsive. This episode explores Confabulation, including some of the brain circuits involved, and what might differentiate confabulation from other kinds of false or implanted memories or delusions.
Please leave feedba...
In 2012 the Supreme Court heard two related cases involving adolescents convicted of murder and sentenced to life in prison without parole because of mandatory minimum sentencing guidelines in their states. One of the boys, Evan Miller along with an accomplice, had beat a man unconscious with a baseball bat after a fight that ensued when the man awoke to find Miller robbing him. Miller and his friend then d...
I am lucky today to be able to bring you an interview with Dr. Zac Brooks who is passionate about serious mental illness (SMI). “What is serious mental illness?” you might ask. That is one of the things we are going to discuss, and you may be surprised when Dr. Brooks explains how it was first formally defined. We also discuss the numerous ways the US has tried to reform how SMI is treated with variable re...
PsyDactic welcomes Dr. Jon Lindefjeld for a discussion of the history of HIV and AIDS. In particular, we discuss the development of effective antiretroviral therapies, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), highlighting the CDC guidelines for use and monitoring, need to treat psychiatric com-morbidities, and the importance of monitoring adherence and drug interactions.
...
Dr. O'Leary discusses some of the history of the borderline personality, how different perspectives have attempted to explain its origin, how to treat it and how not to treat it. He starts in 1947 with some colorful descriptions of patients living with borderline personality disorder that would never get published today, and highlights some of the ways in which we have made progress (or not made progres...
Our current diagnostic criteria for personality disorders have failed to demonstrate validity or reliability. The DSM 5 encouraged psychiatrists to start considering a broad range of personality features adapted from the Five Factor Model. These are combined with global functioning measures to build a personality inventory for any patient who is having dysfunction related to their personality. Proposed crit...
Humans have a history of tattooing that stretches millennia into prehistory. The western ban on tattoos by the early church resulted in a systematic effort to paint tattooed individuals as pagan, primitive, vulgar, criminal, and mentally ill. Psychiatrists have historically contributed to this characterization but are in a position to help reframe how citizens and policymakers view tattooed individuals.
Ple...
The brain understands the world by building models that predict the future. One of the ways that it does this is by utilizing attractor networks. These small world networks are constantly trying to determine what is a true signal from the constant noise in the neural net. Dr. O'Leary explores how attractor networks have been hypothesized to explain psychosis, depression, and obsessive compulsive disor...
When I started to make this episode, I thought I would try to do a comprehensive review of all of the various functions of serotonin across its 15 or more receptor types, but I soon found myself overwhelmed. More importantly, I found that some stories are more interesting to tell than others, so here I discuss serotonin and focus on how a few 5-HT receptors can not only help us survive, but also motivate our...
Frequently I have complained that the terms "typical and atypical" or "first generation and second generation" antipsychotics were not very helpful. When I give chalk talks to junior residents and interns about antipsychotics, this is one of the first things that I note. It is the medicines relative affinities for different receptors that appear to make the difference, not whether they w...
This episode explores side effects of antipsychotics at the molecular level. It starts by exploring receptors and their ligands and takes a turn into the dorsal striatum where dopamine, acetylcholine, serotonin, and glutamate work together to help us dance the mamba. Dr. O'Leary explores what happens when the complex pathways of the cortico-striatal-thalamo-cortical tract are disrupted by antipsychotic...
The authors of the famous sequenced treatment alternatives to relieve depression trial or STAR*D reported that about two-thirds or 67% of patients had achieved remission after 4 trials of antidepressant medication. This remission rate has been questioned over the years and in October of 2023, the journal BMJ Open published an article that reports to have reanalyzed the date from STAR*D using the original st...
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